Secondary pyodermas are far more common and are associated with a persistent or recurrent underlying problem that alters the skin's resistance to infection. Gram stain of exudates from bullous impetigo reveals Gram-positive cocci in clusters. These lesions are often associated to intact but transient follicular pustules. Concurrent bathing every 2 to 7 days with an antibacterial shampoo that contains chlorhexidine or benzoyl peroxide is helpful. Classification of disease is based on the depth of bacterial infection, which is associated with characteristic lesions and recognized clinical presentations. Cutaneous cytology is necessary. may be further opportunistic pathogens. Deep pyoderma is less common but more serious because it expands into the dermis, with a higher risk of bacteremia. Additionally, methicillin-resistant Staphylococcus aureus (human MRSA) is becoming more common among veterinary species. This is the most common type of pyoderma. When deep pyoderma occurs, anaerobic bacteria such as Bacteroides spp., Peptostreptococcus spp., Fusobacterium spp., Porphyromonas spp., and Clostridium spp. trichophyton sp.) Superficial spreading pyoderma is characterized as erythematous macules that enlarge centripetally and create expanding coalescing macules and epidermal collarettes. Nasal carriers of S. aureus can present with a very localized type of impetigo confined to the anterior nares and the adjacent lip area (Fig. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. URL: https://www.sciencedirect.com/science/article/pii/B0721604226500401, URL: https://www.sciencedirect.com/science/article/pii/B9781437707953000843, URL: https://www.sciencedirect.com/science/article/pii/B9781560536260500136, URL: https://www.sciencedirect.com/science/article/pii/B0721628257500060, URL: https://www.sciencedirect.com/science/article/pii/B9780323376518000018, URL: https://www.sciencedirect.com/science/article/pii/B9781416056638000033, URL: https://www.sciencedirect.com/science/article/pii/B9780323376518000031, URL: https://www.sciencedirect.com/science/article/pii/B9781437706574000156, Saunders Manual of Small Animal Practice (Third Edition), 2006, Saunders Manual of Small Animal Practice (Third Edition), Pyoderma, Otitis Externa, and Otitis Media, Linda Medleau DVM, MS, Diplomate ACVD, Keith A. Hnilica DVM, MS, Diplomate ACVD, in, Small Animal Dermatology (Second Edition), Small Animal Dermatology (Fourth Edition), Small Animal Clinical Diagnosis by Laboratory Methods (Fifth Edition), Veterinary Clinics of North America: Exotic Animal Practice, Saunders Handbook of Veterinary Drugs (Fourth Edition). Severe erythematous dermatitis without the typical papular, crusting rash, which is more typical of pyoderma. A. 176-7). S. aureus produces many cellular components and extracellular products that may contribute to its pathogenicity. In many areas, the prevalence of CA-MRSA strains is over 50%.9. Chronic streptococcal pyodermas include lichen simplex of the face, perlèche, and chronic paronychia. Some strains of S. aureus also produce exotoxins, which can cause constellations of cutaneous and systemic symptoms such as staphylococcal scalded-skin syndrome (SSSS) and staphylococcal toxic shock syndrome (TSS). In superficial pyoderma, hair is clipped from the surrounding area, but disinfection is not attempted. Staphylococcus aureus: impetigo. Currently, in industrialized nations, nonbullous impetigo is most commonly caused by S. aureus and less often by group A Streptococcus. Surface pyodermas include the “fold” pyodermas (also known as intertrigo), “hot spots” (also known as pyotraumatic dermatitis), and mucocutaneous pyoderma, which commonly affects German shepherd dogs.1 The last probably has an immunologic as well as a bacterial etiology. These peptides can be found in various locales and include dermicidin, LL-37, protegrin, α-defensins and β-defensins, lactoferricin, and cascocidin. superficial pustular pyoderma synonyms, superficial pustular pyoderma pronunciation, superficial pustular pyoderma translation, English dictionary definition of superficial pustular pyoderma. Jane E. Sykes, ... Stephen D. White, in Canine and Feline Infectious Diseases, 2014. Bullae usually arise on areas of grossly normal skin. The most common cause of pyoderma in dogs is the coagulase-positive Staphylococcus pseudintermedius (previously misidentified as Staphylococcus intermedius) (see Chapter 35 for more information on staphylococci).4 S. pseudintermedius is a normal resident of mucosal sites such as the anus and nares and is thought to colonize the skin transiently following grooming and excessive licking in dogs with pruritus.5 In contrast, the resident flora of the canine skin includes coagulase-negative staphylococci, Micrococcus spp., α-hemolytic streptococci, aerobic coryneforms, Acinetobacter spp., and some anaerobes. Note the early epidermal collarettes associated with some papules. Superficial pyodermas (impetigo, superficial bacterial folliculitis) are bacterial infections that involve the epidermis and/or follicular epithelium. Michael R. Lappin, in Small Animal Clinical Diagnosis by Laboratory Methods (Fifth Edition), 2012. Due to damage to blood vessels in the dermis, bloody discharge or haemorrhagic crusts are common with a risk of haematogenous spread and bacteraemia. esp in plush coated breeds. S. aureus belonging to phage group II can be cultured from the contents of intact bullae. 176-4), and the granulating base extends deeply into the dermis. The most common underlying skin diseases are allergic dermatitis and endocrine diseases, but a variety of other skin diseases can also predispose to pyoderma. Additionally, protein A, staphylokinase, capsular polysaccharide, fibrinogen binding protein, and clumping factor A all act to aid in avoidance of being opsonized and phagocytosed. S. aureus and/or group A Streptococcus can be isolated on culture. When evidence exists for one of these infections, bacterial culture (including bacterial speciation) and susceptibility testing are indicated if systemic antibiotics are thought to be warranted because of the extent and severity of the pyoderma and inherent patient factors. There was a tendency for more frequent episodes of pyoderma in children 2 to 5 years of age as compared to older children. In chronic, recurrent, or deep pyodermas, secondary bacterial invaders may also be present, especially Pseudomonas spp., Proteus spp., and Escherichia coli. Pyoderma associated with hair follicles causes hair loss (alopecia) as the pustules rupture. Symptoms: In addition to the pus-filled reservoirs, pyoderma may initially present as a rash that may or may not itch. The almost universal presence in adults of circulating antibodies to one or more cell-wall antigens or extracellular toxins substantiates the high prevalence of staphylococcal infections. The lesions tend to spread out before they go away. Cutaneous cytology identified cocci, and the patient responded to oral antibiotics administered for 3 weeks. These infections are most likely the result of a transient and non-recurrent insult to the skin. demodicosis, dermatophytosis). You may also find some pimple like pustules on the affected skin. Erythema and crusting on the nose and moustache area (A), which can spread to involve the entire centrofacial region (B). Vets tend to label pyoderma as either “superficial” or “deep.” Again, no great mystery here. Chin pyoderma is a bacterial infection that is not a true acne but rather a traumatic furunculosis. Deep pyoderma is defined by infection deep within the hair follicle, with or without follicular rupture (furunculosis) (Figure 84-2) German shepherd dogs seem prone to a more severe and extensive form of deep pyoderma.3 Other examples include pedal folliculitis and furunculosis, pressure-point pyoderma, pyotraumatic folliculitis and furunculosis, and muzzle folliculitis and furunculosis (“canine acne”). However, S. aureus also has the ability to thwart the immune system in several ways. • Shetland sheep dogs often develop large superficial spreading areas of alopecia, erythema, and scaling. With ever-increasing use of penicillins, methicillin-resistant S. aureus (MRSA) strains have become a major epidemiologic problem since the 1980s. Daily baths and topical treatments can be very beneficial in resolving the infection. Transmission of methicillin-resistant S. aureus (MRS) is mostly from human to pet (reverse zoonosis), but these animals may then be harboring a potential zoonosis. Colonization by S. aureus may be transient or represent a prolonged carrier state. Pyodermas are caused by bacterial colonization or invasion of the skin by coagulase-positive staphylococci, usually Staphylococcus intermedius. These bacteria cause a broad clinical spectrum of infection ranging from superficial pyodermas to invasive soft-tissue infections (STIs; see Chapter 179) depending on the organism, the anatomic location of infections, and on host factors. Treatment of anterior nares and wounds with mupirocin ointment has been shown to decrease S. aureus colonization but in one study did not decrease the rate of transmission to a roommate in a long-term care facility.10 Although there are many other reports of the use of topical mupirocin to reduce colonization of MRSA and methicillin-sensitive S. aureus, indiscriminate use of topical mupirocin must be avoided because significant mupirocin resistance has already emerged. If lesions recur within 7 days of antibiotic discontinuation, the duration of therapy was inadequate and antibiotics should be reinstituted for a longer time period; better attempts to identify and control the underlying disease should be made. Any individuals with open staphylococcal infections are high-risk potential carriers and transmitters of infection. Bullae initially contain clear yellow fluid that subsequently becomes dark yellow and turbid (see Fig. Pyoderma is almost always secondary to an underlying disease process, mainly demodicosis, allergic skin disease, and endocrinopathies (Box 3-1). Superficial Canine Pyoderma is characterized by a condition called impetigo, which is another name for a localized skin infection. Pyoderma tends to affect haired skin, repeatedly traumatized skin (e.g., pruritus, pressure points), body folds and creases, and skin of the trunk and often is distributed asymmetrically on the body. Surface and superficial pyodermas can cause severe itching. However, it is currently unavailable in the United States.15 Systemic antibiotics may be required in extensive cases. In deep pyoderma, hair surrounding the lesion is clipped and the area is disinfected with an antiseptic. The most likely risk factors include previous exposure to fluoroquinilone antibiotics, subtherapeutic antibiotic dosing, and concurrent steroid therapy. RosserJr., in Saunders Manual of Small Animal Practice (Third Edition), 2006. Pruritus is variable, ranging from none to intense levels. Pyoderma is a bacterial skin infection that causes pustules or papules to form on the skin of the dog, which can look similar in appearance to adolescent spots or acne in people. Folliculitis is a pyoderma that begins within the hair follicle, and is classified according to the depth of invasion (superficial and deep), and microbial etiology (Box 176-5). Estos hallazgos histológicos son compatibles con una pioderma de extensióin superficial en conjunción con necrosis dérmica coagulativa. Pyoderma is a common problem in clinical practice. There is no role for general disinfectant treatments or bacitracin.16, Fusidic acid (not available in United States), Amoxicillin plus clavulanic acid; cephalexin. 1. Also, three noninfectious, inflammatory, follicular disorders are more common in black men: (1) pseudofolliculitis barbae, which occurs on the lower beard area (Fig. See Box 176-2 for differential diagnosis of nonbullous impetigo. If lesions do not completely resolve during antibiotic therapy, or if the antibiotics produce no response, antibiotic resistance should be assumed, and a bacterial culture and sensitivity submitted. Cytology identified cocci and ruled out demodicosis. superficial spreading melanoma Dermatology A melanoma, 70% of which affect Pts from age 30 to 60, especially ♀ in lower legs or trunk, as a flat lesion–radial growth phase that may be present for months to yrs, average 5-yr survival 75% Etiology Recreational suntanning. Treatment of pyoderma in the dog typically involves the use of both topical and systemic antibacterial therapies. Ecthyma is a cutaneous pyoderma characterized by thickly crusted erosions or ulcerations. The majority of the primary and secondary pyodermas (cutaneous bacterial infections) are caused by either S. aureus or group A Streptococcus.These bacteria cause a broad clinical spectrum of infection ranging from superficial pyodermas to invasive soft-tissue infections (STIs; see Chapter 179) depending on the organism, the anatomic location of infections, and on host factors. Approximately 60% of S. aureus strains secrete the chemotaxis inhibitory protein of Staphylococci, which inhibits neutrophil chemotaxis. Pseudofolliculitis barbae. The nonbullous type of impetigo accounts for more than 70% of cases of this form of pyoderma. When middle-ear infection is suspected, the animal is anesthetized and material for culture is retrieved by myringotomy by penetration of the tympanum with a sterile CSF needle placed through a sterile otoscope cone. The Nikolsky sign (sheet-like removal of epidermis by shearing pressure) is not present. Superficial pyoderma is one of the most common skin diseases in dogs and almost always has an underlying cause (allergies or endocrine disease). Pyoderma gangrenosum is not infectious. Deep pyoderma involves all the portions of the hair follicle and the dermis ( Fig. Conditions predisposing to S. aureus colonization include atopic dermatitis, diabetes mellitus (insulin dependent), dialysis (hemo- and peritoneal), intravenous drug use, liver dysfunction, and human immunodeficiency virus (HIV) infection. Although not antibacterial per se topical ceramide creams may help improve the barrier function of the skin, especially in atopic dogs, thereby limiting the chance for infection reoccurrence. Among the acute streptococcal pyodermas are impetigo, diffuse superficial streptococcal pyoderma, and ecthyma, an ulcer that forms beneath a dried phlyctena. 176-2) that quickly evolves into a honey-colored crusted plaque that can enlarge to greater than 2 cm in diameter (see Fig. The dog may have hair loss and the skin may become red. This uncommon clinical presentation is … In superficial pyoderma, bacteria infect the superficial epidermal layers that lie immediately under the stratum corneum (the outermost layer of the skin) and the portion of the hair follicle above the sebaceous duct (the infundibulum) (Figure 84-1). The moth-eaten alopecia is typical of pyoderma in short-coated breeds. superficial spreading pyoderma. ficial spreading pyoderma” denomination.14 However, despite proposed changes in disease terminology, the characteristics of epidermal collarettes remain poorly characterized and it is still classified under the umbrella term of “superficial bacterial folliculitis”.15 Intact skin is usually resistant to colonization or impetiginization, possibly due to absence of fibronectin receptors for teichoic acid moieties on S. aureus and group A Streptococcus. So-called bullous varicella represents superinfection by S. aureus (phage group II) of varicella lesions (bullous impetiginization). If family members or people in close contact with the patient are immunosuppressed, the veterinarian should be aggressive in assessing the risk for zoonosis and contagion, culture the patient to identify MRS, discuss isolating the patient from at-risk people, and so on. In an adult with extensive or bullous lesions, dicloxacillin (or similar penicillinase-resistant semisynthetic penicillin), 250–500 mg orally (PO) four times daily (qid), or erythromycin (in the penicillin-allergic patient), 250–500 mg PO qid, should be given. Pyoderma gangrenosum is a rare, inflammatory skin disease where painful pustules or nodules become ulcers that progressively grow. Exposure to mineral oils, tar products, and cutting oils can cause an irritant folliculitis. In superficial pyoderma, bacteria infect the superficial epidermal layers that lie immediately under the stratum corneum (the outermost layer of the skin) and the portion of the hair follicle above the sebaceous duct (the infundibulum) (Figure 84-1). If CA-MRSA is likely, consider the following therapies: TMP-SMX and rifampin (100%), clindamycin (95%), and tetracycline (92%). This uncommon clinical presentation is mainly seen on the ventral body. Transfer of organisms to patients occurs predominantly via the hands of personnel rather than through the air. The disease was identified in 1930. Conditions that disrupt the integrity of the epidermis, providing a portal of entry of impetiginization, include insect bites, epidermal dermatophytoses, herpes simplex, varicella, abrasions, lacerations, and thermal burns. Deep Canine Pyoderma refers to deep inflammation on the hair follicle, and the possible presence of out types of skin conditions such as canine acne. As a result, 5%–30% of resting T cells may be activated, whereas the “normal” antigenic response is only 0.0001%–0.01% of T cells.6 Nonspecific T-cell activation leads to massive systemic release of cytokines, especially interleukin 2, interferon-γ, and tumor necrosis factor-β from T cells and interleukin 1 and tumor necrosis factor-α from macrophages.7 Superantigen stimulation of T cells also results in activation and expansion of lymphocytes expressing specific T cell-receptor variable region of the β-chain. The infection is almost always secondary to an underlying cause; allergies and endocrine disease are the most common causes (Box 3-3). Ulcer characteristics: This form of the disease presents as concentric bullous areas that spread rapidly in a concentric pattern. Treatment: topical, oral, or parenteral antibiotics; change predisposing conditions, if possible. Pyoderma has three different types. Alopecic dermatitis with a purulent exudate on the lip of a dog. If the hair follicle ruptures, the infection is released into the surrounding tissue leading to swelling and sinus formation. However, with the increasing frequency of methicillin-resistant and multi-drug resistant Staph.organisms, bacterial culture and sensitivity testing would be recommended for those patients who had received systemic antibiotics within the past 6 months. MRS superficial pyoderma can usually be effectively treated with the daily to every other day use of topical treatments and, when possible, systemic antibiotics, but time to clinical resolution may take longer for these infections. Recent evidence demonstrates that S. aureus can invade and survive in many types of host cells, suggesting that a cell-mediated immune response may be required for killing intracellular organisms. A central cicatrix surrounded by pustules and papules gives the appearance of lupus vulgaris (see Chapter 184). It affects approximately 1 person in 100,000 in the population. Pyoderma refers to any pyogenic infection of the skin and is most commonly used in reference to bacterial skin infections. Deep pyoderma can be seen with any underlying trigger or acquired immunodeficiency, and it is commonly associated with demodicosis. It is often found in people with other underlying illnesses, such as inflammatory bowel disease, rheumatoid arthritis, or some hematological malignancies. Atypically shaped erythematous lesions in an allergic dog. Lesions are often swollen, haemorrhagic and pain-ful. Three types of skin eruptions can be produced by phage group II S. aureus, particularly strains 77 and 55: (1) bullous impetigo, (2) exfoliative disease (SSSS), and (3) nonstreptococcal scarlatiniform eruption (staphylococcal scarlet fever). We use cookies to help provide and enhance our service and tailor content and ads. Focal area of alopecia caused by folliculitis in an allergic dog. A small, fragile, dome-shaped pustule occurs at the infundibulum (ostium or opening) of a hair follicle, often on the scalps of children and in the beard area (Fig. Over the past 5 years, clonal spread of methicillin-resistant S. pseudintermedius has occurred across Europe and North America.12 Methicillin resistance has also been described among S. schleiferi and S. aureus isolates from dogs with pyoderma.8 These organisms encode an altered penicillin binding protein that incurs resistance to all β-lactam antimicrobials, and many also demonstrate resistance to fluoroquinolone antimicrobials. Dermatophytic folliculitis must be differentiated from S. aureus folliculitis. By far, superficial bacterial folliculitis (SBF) is the most common presentation of pyoderma in dogs. Superficial pyoderma; Deep pyoderma; Surface and superficial pyoderma can cause severe itching in your dog and can also be the cause of hair loss near the infected area or the redness in skin. In a study of bullous impetigo, 51% of patients had concurrent S. aureus cultured from the nose or throat, and 79% of cultures grew the same strain from both sites. Bacterial culture: Staphylococcus species. 2 regions where staph like to hang out. Sycosis barbae is a deep folliculitis with perifollicular inflammation occurring in the bearded areas of the face and upper lip (Fig. Superficial pyoderma is a superficial bacterial infection involving hair follicles and the adjacent epidermis. Pyoderma refers to any pyogenic infection of the skin and is most commonly used in reference to bacterial skin infections. Pyoderma is one of the most common diseases of the dog. In cats, pyoderma is uncommon to rare, although feline acne can be classified as a pyoderma. DIAGNOSIS Generalized dermatitis in an allergic dog. Treatment should be continued for 5–7 days (10 days if Streptococci are isolated). Isolated staphylococcal folliculitis is common on the buttock of adults. Until the underlying problem is identified and corrected, the infection usually responds only temporarily to therapy and subsequently recurs. Multiple thickly crusted ulcers on the leg of a patient with diabetes and renal failure. If untreated, invasive infection can complicate S. aureus impetigo with cellulitis, lymphangitis, and bacteremia, resulting in osteomyelitis, septic arthritis, pneumonitis, and septicemia. S. aureus can cause secondary infection in these inflammatory disorders. The papular rash typical of pyoderma persisted despite high-dose antibiotic therapy, suggesting the antibiotic-resistant nature of the organism. In older adults, S. aureus accounts for 9% of nosocomial infections and follows only Escherichia coli, Pseudomonas aeruginosa, and Enterococci in prevalence.5. Chin pyoderma is common in dogs, especially in young (3- to 12-month-old), large, short-coated breeds. Both S. pseudintermedius and S. schleiferi may develop methicillin resistance, especially if subtherapeutic doses of antibiotics or fluoroquinilone antibiotics have been used previously in the patient. "Bacterial hypersensitivity" and/or superficial spreading pyoderma: bacterial hypersensitivity is an uncommon disease based on a clinical triad: erythematous follicular pustules, target lesions/seborrhoeic plaques, haemorrhagic bullae. See Box 176-3 for differential diagnosis of bullous impetigo. In superficial pyoderma, bacteria infect the superficial epidermal layers that lie immediately under the stratum corneum (the outermost layer of the skin) and the portion of the hair follicle above the sebaceous duct (the infundibulum) (Figure 84-1). Dogs with deep pyoderma may require daily baths with medicated shampoos diluted to one-half or one-quarter strength. Lupoid sycosis is a deep, chronic form of sycosis barbae associated with scarring, usually occurring as a circinate lesion. Staphylococcal impetigo responds quite promptly to appropriate treatment. Pruritus may or may not be a feature of the clinical picture. S. aureus is an aggressive pathogen and the most common cause of primary pyodermas and STIs, as well as of secondary infections on disease-altered skin. (Fig 2) and superficial pyoderma (Fig 3) are restricted to the epidermis and do not pen-etrate below the basement membrane; they are typically pruritic. In general, topical formulations that are not rinsed off will have a longer treatment effect. Large pustules within an erythematous papular rash are an uncommon lesion in association with pyoderma. Less commonly seen than superficial pyoderma, deep pyoderma breaks through hair follicles to involve the deep layers of the skin, resulting in furunculosis and cellulitis. 176-3A), and their margins are sharply demarcated without an erythematous halo. Systemic reactions include: staphylococcal toxic shock syndrome and scarlatiniform eruption. Secondary pyodermas can be caused by: The severe inflammation is similar to staphylococcal scalded skin syndrome in humans. Methicillin-resistant Staphylococcus aureus (MRSA), methicillin-resistant S. schleiferi (MRSS), methicillin-resistant S. intermedius (MRSI), and methicillin-resistant S. pseudintermedius (MRSP) are emerging problems in some regions of the United States. It may be induced by trauma to the chin (e.g., caused by lying on hard floors, friction from chew toys). Regardless of the presence of methicillin resistance, patients should be reexamined near the end of the treatment schedule to ensure clinical resolution of pyoderma or lack thereof. Although S. aureus infection prevalence has not changed much, the percentage of MRSA isolates of these infections has significantly increased in some countries. Given the potential for (reverse) zoonosis, veterinarians must practice good infection control practices with each case of pyoderma (e.g., washing hands, cleaning and disinfection), with these measures enhanced when MRS has been documented in the patient (e.g., gloves, protective outerwear, separation of MRS patient from rest of hospital patients). Although conventional antigens require recognition by all five elements of the T-cell-receptor complex, superantigens require only the variable region of the β-chain. All three types of Staphylococcus may be zoonotic, moving from human to canine or from canine to human; immunosuppressed individuals are at greatest risk. Untreated ecthymatous lesions enlarge over weeks to months to a diameter of 2–3 cm or more. It occurs in children of all ages as well as in adults. Sterile pyogranulomatous dermatitis. 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